The Health and Social Care Committee concluded in November 2025 that ophthalmology services in Wales are under increasing pressure, and that delays are putting patients at risk of avoidable sight loss.
The Welsh Government accepted only two of the Committee’s 17 recommendations in full. While its response points to ongoing reforms, it defers several key decisions and offers few short‑term actions. As a result, the Committee has taken the unusual step of requesting a supplementary paper. It is seeking clearer explanations for the absence of immediate measures ahead of new governance arrangements, the lack of interim plans to maintain progress on estates and equipment, and the omission of direct responses to workforce recommendations.
This article explores why the Welsh Government’s approach might be viewed as overlooking urgent short‑term risks, despite its strong emphasis on long‑term vision (see our previous article, Losing Sight: Why eye care in Wales needs urgent attention).
The urgency
The Committee emphasised that ophthalmology is among the most pressured parts of NHS Wales, and that delays are already leading to harm. By the end of December 2025, more than 78,000 patients in the highest clinical risk category were waiting beyond recommended timeframes — around half of all high risk pathways — leaving people with time-sensitive conditions like glaucoma and macular degeneration at increased risk of irreversible sight loss.
Demand continues to rise. The Royal College of Ophthalmologists projects a 16% rise in glaucoma prevalence and a 23% rise in severe macular degeneration over the next decade. An estimated 110,000 people in Wales are already living with sight loss, with numbers expected to grow.
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What data does the Welsh Government publish on eye care? The Welsh Government publishes annual “Eye care statistics”, which cover both primary (community optometry) and secondary (hospital eye services) care, as well as data from Diabetic Eye Screening Wales (DESW). These provide an overview of how eye care services are delivered and how demand is changing. |
Monthly “Eye Care Measures for NHS outpatients” show the numbers of new and follow-up ophthalmology patients waiting within their target date or within 25% beyond it. Patients who exceed their target date are categorised as being at risk of irreversible harm or significant adverse outcomes (Health Risk Factor R1).
Ophthalmology continues to be among the busiest outpatient specialties, with around 108,000 open patient pathways in 2024–25 — more than double pre‑pandemic levels. In August 2025, 29,392 ophthalmology patient pathways had been waiting over one year for treatment.
Patients and charities have described the personal impact clearly: reduced independence, difficulties maintaining employment, heightened anxiety, and in some cases, permanent sight loss before treatment could be provided.
Given this context, the Committee’s 17 recommendations focused not only on long‑term transformation but also on immediate actions to increase capacity, strengthen governance, and improve transparency. This approach was welcomed by organisations including RNIB Cymru, which reiterated that delays are already causing avoidable sight loss.
What the Welsh Government has already done
It is important to acknowledge the significant measures already taken. The Welsh Government endorsed a new National Clinical Strategy for Ophthalmology, based around organisational reform, clinical networks, pathway redesign, and sustainable models capable of meeting rising demand and reducing risk. It also convened a Ministerial national summit in October 2024 and instructed health boards to prioritise patients at the highest clinical risk.
Funding for primary eye care has increased, including a £3.9 million uplift in 2024–25 to expand community‑based services and help relieve hospital pressures. Welsh Government figures indicate around 30,000 additional community appointments are expected by March 2026.
Cataract surgery, which accounts for around 50% of all ophthalmology waiting lists in parts of Wales, has been prioritised within the broader planned care recovery programme, with a 2025–26 package aimed at delivering 20,000 additional procedures. Regionally, the high‑volume cataract model in South East Wales has delivered measurable progress, including a shared waiting list, accelerated booking processes, and by March 2025, the elimination of waits over 104 weeks in Cardiff, Aneurin Bevan and Cwm Taf Morgannwg health boards.
The Committee noted that although these measures are welcome, they have not yet resulted in clear reductions in hospital bottlenecks or in the harms associated with delays, particularly for high‑risk patients. It has also sought further clarity on how the Welsh Government’s formal response addresses the gap between long‑term reform and the immediate needs identified in its report, requesting a supplementary paper for this purpose.
The Royal College of Ophthalmologists has also highlighted that increases in cataract productivity may provide only a partial picture of recovery, as the greatest clinical risks arise in more complex hospital‑based treatments.
The Welsh Government’s response
Limited short-term action despite time‑critical risk
Although the Welsh Government acknowledges the severity of current pressures, its response focuses largely on longer‑term governance and national transformation. These may improve services over time, but the response does not set out concrete short‑term measures to protect patients already waiting beyond clinically safe timeframes.
Deferring key decisions into the next Senedd term
With a Senedd election scheduled for May, several key decisions have been postponed. For example, the Welsh Government has chosen not to establish the recommended oversight board before the election, instead delaying structural decisions until after the ongoing governance review concludes in April 2026. An interim taskforce could have been created in the meantime. While this caution is understandable in the context of the electoral cycle, the Committee remains concerned that such delays do not reflect the level of clinical urgency highlighted by both patients and clinicians.
Governance reform without interim accountability arrangements
Governance changes are expected to be completed by April 2026. However, the response does not explain what interim arrangements will ensure oversight of estates decisions, equipment replacement and capacity constraints — issues that are already limiting throughput.
Harm reporting: limited clarity on implementation
Although the Welsh Government says a standardised harm reporting protocol (i.e. a single, nationally agreed system for identifying and reporting harm from delays in ophthalmology care) is already in place across health boards, it has not set out milestones or performance expectations to ensure consistent use. Given the evidence of harm caused by delays, the lack of time‑bound commitments may undermine confidence in how effective this protocol will be in practice.
Workforce: insufficient focus on immediate capacity
Workforce gaps — including consultant ophthalmologists, specialist nurses, optometrists with higher qualifications, and theatre staff — are central to the backlog. The Welsh Government’s response largely defers these issues to Health Education and Improvement Wales (HEIW), without setting out the short‑term actions needed to stabilise capacity.
Targeted investment but limited scope
Targeted investment has supported increased cataract throughput, including through insourcing (bringing external staff into an organisation to deliver services in‑house) and use of the independent sector. However, the response does not ring‑fence funding for wider hospital‑based ophthalmology pressures, where clinical risk is greatest. This is despite the Cabinet Secretary acknowledging that ophthalmology is one of the most challenged specialties and requires ongoing investment.
Why more is still needed
The Committee’s recommendations emphasised that practical, short‑term measures could sit alongside the Welsh Government’s longer‑term reforms. The inquiry supported the role of community optometry in managing lower‑risk demand, but indicated that this must be matched by secure funding for hospital ophthalmology, where the highest‑risk patients are seen.
The Committee emphasised that secondary care services remain under‑resourced relative to current demand, and workforce shortages, ageing estates and delays in digital upgrades predominantly affect hospital‑based care. These require immediate capacity‑building while longer‑term reforms progress.
Against this backdrop, and in light of the scale of the issues highlighted by the Committee, some may question whether the Welsh Government’s response sufficiently aligns long‑term strategic aims with the immediate clinical urgency identified in the report. This may not reflect a lack of strategic intent, but rather the challenge of ensuring that urgent short‑term actions and clear accountability mechanisms match the level of clinical risk. In ophthalmology, timely intervention is particularly important, as delays can make the difference between preserving sight and preventable sight loss.
The Senedd will debate the Committee’s report and Welsh Government’s response on Tuesday 25 February. The debate can be watched on SeneddTV and a transcript will be made available shortly afterwards.
Article by Sarah Hatherley, Senedd Research, Welsh Parliament
